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AimsComplex multitasking, multiple pressures, and frequent demands on a new consultant are daunting. We designed a course to give candidates extension beyond their clinical knowledge. We describe the inspiration, delivery, and feedback from our novel all day Consultant role simulation course aimed at ST8 paediatric traineesMethodsA full day simulation course devised for final year paediatric trainees, to support transition to Consultant working. Simulation components included:Leading a neonatal resuscitationDealing with complex ward situationsPreparing a written media statementA media interviewEmergency department resuscitationSpeaking to parents about a complaintOffice time with inbox problemsSpeaking to the Coroner and tertiary expertsAnalysing a service improvement problemA handover to the evening consultantDelivering a short presentationThe simulation events were run continuously and in parallel, demanding real time prioritisation, time management, leadership and managerial skills. Candidates were also expected to demonstrate their ability to prioritise their ‘inbox’ tasks and prepare a presentation. The day was delivered by senior trainers, simulation experts and professional actors in a bespoke simulation centre.Results and feedbackFeedback was very positive after a long, intensive day. On a 1–5 scale candidate scores were:Abstract G88(P) Table 1Candidate feedbackThe overall content was useful to me4.7The course is novel and important to senior trainees4.9I have learned a lot about how to behave as a senior healthcare professional4.2I will recommend this course4.9PrePostI feel confident to act as a first year consultant3.23.7I’m terrified of making a mistake3.62.9I’m pleased to be here today4.24.6Highest rated session was the media session scoring 4.8. Mean score for all sessions was 4.5, with no session scoring below 4.2.ConclusionOur feedback shows there is a need and desire for a course which exposes trainees to some of the aspects of being a consultant which are not otherwise addressed. The use of professional actors improved the fidelity of the course and the reliability of the simulations. We believe this course is an important addition to training.

ObjectivesRCPCH Trainee Charter recommends at least 8 hours a month for ST1–3 Postgraduate doctor in training (PGDiT) pro rata for Less Than Full Time (LTFT) PGDiT for Supporting Professional Activity (SPA).1 This has been difficult to implement in Yorkshire and Humber deanery due to staffing concerns and its absence in the Junior Doctor contract. In an audit in the deanery, less than 28% of trainees responded yes to having at least 4 hours per month for SPA.The General paediatrics Tier 1 rota at the tertiary hospital Hull Royal Infirmary (HRI) comprises 11 persons and does not provide SPA time, leaving Lower Specialty Trainee, LST, with personal development time.This abstract aims to demonstrate that with adequate planning, there can be dedicated SPA time allocation in the rota for paediatric PGDIT and that using this model, Paediatric LST can have more exposure to clinics. This will also increase the conversation around trainee-led rota planning.MethodsAn LST was assigned to manage the tier 1 rota between May-August 2023. They identified dates for SPA time and clinics. This data was collated and analysed retrospectively.ResultsFigure 1 Chart Showing SPA hours per Postgraduate Doctor In Training (PGDiT) (PGDiT got an equivalent amount of time for the clinic).A whole day was allocated per person for SPA time and clinic with a plan to attend clinic half of the day. All the Tier 1 got an average of at least 4 hours of SPA time per month. However, the graph above is focused on the Paediatric PGDIT. An added benefit was four clinic hours per month, improving training exposure. Teaching days and leaves were taken into consideration and impacted SPA allocations.Abstract 6494 Figure 1Chart showing SPA hours per postgraduate doctor in training (PGDiT) (PGDiT got an equivalent amount of time for the clinic)ConclusionWith good planning, collaboration with the rota team and support from the college tutor, it is possible to implement SPA time as well as improve clinic attendance. PGDiT must adopt the excellent practice of requesting annual and study leaves at least six weeks in advance to enable planning.There is an ongoing effort to trial this in other regional Trusts. There is a need for further work to focus on increasing SPA time to a minimum of 8 hours per month for LST as per RCPCH recommendation.Trainee-led rotering can lead to an improvement in the training experience, and trainees value getting more outpatient clinic time as per feedback received.ReferenceTrainee Charter by RCPCH available at https://www.rcpch.ac.uk/resources/trainee-charter

ObjectivesThe RCPCH trainee charter was launched in 2019, stipulating trainees be rostered for at-least 8 (ST1–3) or 16 (ST4+) hours/month of supporting professional activity (SPA) time to complete non-patient-facing work-related activities. This includes ARCP-critical tasks arising from the trainees’ curricula such as QIPs, teaching, and e-portfolio engagement, all of which typically cannot be completed during clinical duties. This recommendation is further reinforced by the 2023 RCPCH Thrive guidance advising the standard be met as part of developing sustainable rotas to support trainee wellbeing. Additionally the GMC’s Caring for Doctors recommendations advise that SPA time improves doctors’ working lives by increasing their autonomy and competence. Presently no mechanisms exist to enforce the charter’s recommendation. We aimed to evaluate whether London trainees’ placements were meeting the charter’s recommendations.MethodsAll London trainees were invited to complete a voluntary, anonymised annual survey on their March-September 2023 rotation. Newly introduced this year were questions exploring whether trainees had access to SPA time as per the charter.Results705/778 (90%) ‘in-programme’ trainees responded, covering 31 training sites (8 tertiary, 17 DGH, 2 specialist, 4 community).27% reported being able to take at-least the recommended time; 23% were rostered for but unable to take the time; 50% had not been rostered for the recommended time. There was minimal variation between ST grades. Variations were noted by placement type (see table 1), with community placements having the most trainees being able to have the recommended SPA time (53%), followed by tertiary placements (35%). 60% of trainees at a DGH were not rostered for the recommended SPA time.Free-text comments indicated that when rostered, SPA time was rarely ringfenced, resulting in trainees being pulled to clinical duties. In some cases, SPA time was sacrificed so trainees could meet minimum leave entitlements. Some negative comments relating to placement experience alluded to being unable to have SPA time, resulting in trainees having to complete work in their own time.Abstract 6895 Table 1ConclusionOur comprehensive sample shows the prevalence of London trainees being able to achieve the College charter’s SPA benchmark being at just over a quarter. It shows that a disconnect exists between what trainees are rostered for versus what happens. SPA time is clearly valued by trainees and contributes to trainees’ satisfaction with their placements. Next steps include exploring with trainees and trainers the barriers and enabling factors and to see how placements can better achieve charter standards with a view to maximise trainees’ wellbeing.

High volume cataract lists are cost-effective, reduce waiting times, and facilitate surgical teaching. We propose a stepwise training model that incorporates human factor principles and a reflective pedagogical approach, which has not been documented previously. Surgical training in ophthalmology is effective when a modular approach is utilised. High volume lists further enhance training by increasing exposure to a newer way of learning and working. We evaluated the efficiency and safety of trainee-assisted cataract surgery across a single NHS eye unit and an independent sector (IS) provider. We examined results from audits of surgical efficiency and safety in trainee-assisted high-volume lists, including a single-centre comparative evaluation of consultant-only and trainee lists. The quantitative and qualitative information gained from these projects helped us to implement a modular, structured training programme that utilises a reflective cycle of pedagogy, suitable for any grade of trainee. Our projects included an audit following cataract surgery performed by a surgical trainee over a 5-month period, which showed excellent post-op refractive results and no cases of intra-operative and post-operative complications. A single-centre observational study demonstrated comparable surgical throughput and safety results for trainee and solo consultant high volume lists. Systemic and ocular complication rates were reported to be similar for low and medium risk cataract surgery among trainee supervised IS and NHS lists. Cataract surgery outcomes and patient feedback support the effectiveness of the surgical training model. Combining Gibbs' reflective cycle of critical reflection with the International Council of Ophthalmology's principles helped us to develop the QM Model of modular teaching for cataract surgery, which we believe is suitable for utilisation in all surgical centres in the NHS and IS settings, for both low volume and high-volume surgical lists regardless of trainee experience.

ObjectivesSubspecialty applications within paediatrics is a competitive application process for senior trainees wanting to undergo subspecialty training in 18 different paediatric subspecialties. In the East Midlands, we currently provide opportunities within 6 of these subspecialties, however the success rate was disappointing. It has also been noted there is a decline with interview skills within paediatrics since the evolution of run through training. In order to support trainees, a quality improvement project was developed to understand the success rate with a plan to improve this using the quality improvement methodology.MethodsRates of subspecialty application success was used as a baseline. Using a serial ‘Plan, Do, Study, Act’ (PDSA) model the School of Paediatrics developed a suite of interventions to provide information and develop skills for local trainees wanting to undertake subspecialty training.The first intervention was a subspecialty careers day, aiming to allow local trainees to gather information about the specialty, the application process and tips on how to best succeed in writing their applications. The next PDSA cycle developed mock interviews for trainees offered an interview to further improve the success rate through developing interview skills. This was initially face-to-face and changed to virtual according to the changes due to COVID-19. Our current PDSA cycle is focusing on expanding the network of application reviewers and further developing the mock interview process. We have also introduced a regional subspecialty representative on the regional Education and Training Committee to be a point of contact for aspiring candidates.ResultsBaseline data identified a relatively low success rate. Modest improvements were noted in the first PDSA. The mock interview interventions demonstrated that around 80% of those participating were appointable for subspecialty training, showing further overall improvement.ConclusionSubspecialty application processes are challenging for any trainee, and we sought to improve local access to these opportunities through deanery-wide interventions to improve quality of applications and encourage access for those who might have struggled without regional support. Our current interventions have shown incremental success and we hope that our ongoing endeavours continue to improve subspecialty application success rates in the future.

ObjectivesOutpatient clinic experience is a significant part of paediatric trainees’ development, both with new and follow-up patients. However, it is uncommon for a trainee to follow-up their own patients, limiting the feedback available following the initiation of treatment plans or ordering of investigations, and reduces the development of therapeutic relationships with patients and their parents/carers. We piloted a new initiative for a neurology trainee at Great Ormond Street Hospital to build their own caseload through their own dedicated clinic.MethodsThe trainee’s weekly dedicated general neurology clinic was developed from the existing list of patients referred for outpatient neurology review. One hour was provided for new patient appointments, and 30 minutes for follow-up appointments. Cases were discussed with the supervising consultant prior to or during the clinic appointment. The trainee was then responsible for clinical review, parent/carer discussion, arranging and reviewing investigations, initiating management, and dealing with subsequent patient or referrer messages. Patients needing a follow up appointment were booked into this same clinic.ResultsIn the initial 8-month period, 23 new patients were seen with 19 subsequently booked in for a follow-up appointment. Primary complaints included headache (4), neurodevelopmental concerns (7), seizures/paroxysms (6), movement disorders (4), and others (2). Two patients required eventual transfer of care to the consultant due to patient complexity. No patients suffered harm. All letters were sent out within the department-agreed 7 days following the appointment, with most completed within 72 hours.All but one of the patients’ parents/carers were happy to see the same trainee for further appointments. Formal compliments were received from 2 patients, both appreciative for the care received.ConclusionsThis novel clinic allowed the trainee to develop their own case load with support and follow their own patients during their diagnostic and treatment journey. This allowed for this senior trainee to better understand and practice the nature of outpatient management as a consultant. More importantly, we found this set-up enabled a positive experience for patients and parents/carers families, with consistent communication and managing of expectations.Factors for success included administrative support, a commitment for an appropriate consultant to supervise, ongoing communication between the trainee and consultant, and most pertinent, time within the trainee’s rota to undertake the clinic. We hope that this successful initial trial can be extended to senior trainees in our department and act as a model to allow future resident doctors to have a supervised case load.

IntroductionFormal teaching during Genitourinary Medicine (GUM) training in the United Kingdom traditionally entailed ad hoc local, regional and an annual face to face Doctors in Training (DIT) day. As a result, GUM trainees received inconsistent teaching opportunities particularly in deaneries with lower trainee numbers. A project to address this disparity was commenced in 2020.Methods98 GUM trainees registered with JRCPTB in 2020 were surveyed on the frequency of deanery based, formal, regional curriculum teaching. This was conducted via an online questionnaire (30.06.20–29.07.20).ResultsThere were 39 respondents (38% of all trainees), representing from 14 of the 15 deaneries, between ST3-ST6. Prior to COVID-19, 61% received formal teaching, monthly minimum. All respondents were interested in collaborating either regionally (41%) or nationally (60%) to improve national access to teaching. GUM trainees in the West Midlands deanery had procured access to a bespoke Postgraduate Virtual Learning Environment (PGVLE). This platform hosts live events, stores video recordings, relevant files and supports feedback analysis. The opt-in national teaching program was launched in June 2021 with three days completed at the time of writing. 90% of trainees attended felt their access to virtual teaching nationwide had greatly improved. 52% prefer a hybrid of face-to-face and virtual teaching to meet their learning needs.DiscussionEstablishment of a biannual virtual national teaching program in lieu of an annual DIT day has been well received by trainees. Additionally, the program promotes opportunities for trainees to plan and deliver training days, benefiting career development.

ObjectivesMembership examinations are vital for trainee progression, culminating in the Clinical examination. Following changes to its format, trainees in our deanery no longer had access to a regionally co-ordinated Clinical examination course. Our large geographical area covers 200 miles end-to-end including remote rural locations with only one tertiary children’s hospital, and the change in examination format post-pandemic had reduced previous tutors’ confidence in supporting trainees. However, given the significance of the Clinical examination for trainees, provision of support needed addressing.Our aim was to reintroduce a formal face-to-face mock examination for trainees preparing for the MRCPCH Clinical examination.MethodsAll regional trainees were approached via e-mail from the regional paediatric school and newsletter. Trainees revising for the Clinical examination were invited to register for a teaching programme, peer mentoring and mock examination organised by a working group including a teaching fellow and deanery-appointed examination representatives. For the October 2023 diet 13 trainees enrolled for teaching and seven registered for the mock; five attended. The course was free for trainees, costs covered by Covid-19 recovery funding.The format was designed by the working group, two members of which had personal experience of the new examination format. The mock examination followed the current structure encompassing all stations, including patients in clinical stations. All examiners were briefed, provided with RCPCH guidance and mark sheets. Mentors were allocated for candidates. Candidates were asked to share their pre-course expectations and concerns and give post-course feedback.ResultsCandidates stated that their expectations were to practise, experience, and receive feedback on all stations. Candidates were most apprehensive about neurological and musculoskeletal examinations, missing clinical signs, history-taking, communication, summarising, and formulating management plans.Formal feedback was positive, including use of real patients, realistic scenarios, and objective examiners providing thorough feedback (figures 1–3). Candidates commented it gave a clear picture of what the examination would look like. Suggestions for improvement were more video, history and development stations, and the possibility of combining the mock with teaching sessions over two days.ConclusionOur re-introduction of the mock examination was successful, with universally positive feedback. Candidates found it useful, and examiners enjoyed it, showing interest in helping again. Our vision is to run the mock six monthly, embedding it within the annual training calendar and ensuring sustainable funding. We hope a regular event will improve buy-in from faculty and patients, enabling a high-quality day for examination preparation with potential for future expansion.Abstract 6838 Figure 1General course and individual session feedback. Candidates n = 5Abstract 6838 Figure 2Do you feel you had adequate opportunity to practice today?’ Candidates n = 5.Abstract 6838 Figure 3Overall satisfaction of the course. Candidates n = 5.

ObjectivesThe ‘weekly teaching e-mail’ is a trainee initiative started in March 2023 and aims at keeping doctors with an interest in child neurology (working or not at Great Ormond Street Hospital-GOSH) updated about training activities and events (e.g. weekly seminars/lectures, workshops, congresses, podcasts, journal clubs) related to child neurology and happening either physically or virtually. In parallel, comments and thoughts about training and educational issues are shared. The objective of this study was to describe the views and experiences of doctors regularly receiving the weekly teaching e-mail and to investigate the impact of the e-mail on their professional life.MethodsA survey was made consisting of 16 questions and was distributed via e-mail to all people receiving the weekly teaching e-mails between March 2023 and October 2023.ResultsA total of 20 doctors replied with 85% currently working at GOSH. All 20 people found the weekly teaching e-mail useful in keeping them updated about neurology-related training activities and all 20 people felt that it contributes to their professional development. In parallel, 90% (18/20) believed that the weekly e-mail helps them save time when looking for neurology-related teaching/training activities and 95% (19/20) found that it contains a good mixture of suggestions for neurology-related teaching activities from multiple sources. In total, 16/20 (80%) stated that the weekly e-mail informs them about activities or websites of which they would never be aware, 14/20 (70%) highlighted that it helps them reflect on their everyday practice and 15/20 (75%) stated that it helps them feel connected with other colleagues working in the same field. Furthermore, 17 out of 20 participants mentioned that the weekly teaching email increases their general interest in paediatric neurology, while >50% of participants (11/20) felt that they can repurpose the context of the weekly teaching e-mail to pursue their interests in other fields of medicine. When participants were asked to provide free-text comments, they highlighted aspects of ‘consistency’, ‘excellent summary’, ‘passion and enthusiasm’ and ‘detailed information’.ConclusionA weekly teaching e-mail can enhance the coherence of a team, improve aspects of training, increase the interest in specific fields and contribute to professional development. Small initiatives can have multiple benefits and lead to bigger changes. Trainees’ initiatives and new ideas should be encouraged in the workplace.

ObjectivesWrightington, Wigan and Leigh NHS Trust trains foundation, GP and paediatric trainees and Clinical fellows. In 2019–2021 the GMC NTS rated local teaching ‘significantly below the national score’.1 The RCPCH tutors and trainee teaching representatives aimed to utilise a variety of strategies to improve and develop teaching.MethodsTeaching trainee representatives were intentionally recruited to the education team with widening participation in mind.Pastoral care trainee meetings reflected on positive educational opportunities, and limitations: including teaching location, clinical pressures and attendance/engagement. Action plans were created, with a case for financial backing.Weekly teaching included clinical topics, mortality/morbidity/audit meetings and journal clubs, with internal and external speakers and multidisciplinary collaboration. To maximise attendance a projector and laptop were purchased, Microsoft Teams channel created, and teaching delivered as ward-based hybrid ‘agile teaching’. Seniors held bleeps for trainees.Weekly FY2-ST2 led teaching provided quick education updates, delivered informally with senior support after handover to maximise attendance. Teaching feedback forms and certificates encouraged speakers and attendance was tracked.A new trainee education Whatsapp group helped share teaching location, links and feedback, disseminate educational updates and additional teaching provisions, including local courses, regional teaching and safeguarding meetings.A ‘star of the month’ was created, with colourful medals and portfolio certificates, celebrating achievements and encouraging trainees.Communication meetings used anonymous feedback along with college tutor discussion to support trainees wellbeing and further develop educational experiences.ResultsThe GMC NTS score increased from negative outliers- 38.61 (2019) and 44.17 (2021) to average- 58.89 (2022) and 59.24 (2023) (figure 1)Abstract 6342 Figure 1The Education and Rota team won ‘Making WWL the Best Place to Train’ at the WWL Recognising Excellence in Medical Education awards.In 2023 attendees rated ‘agile teaching’ 4.8/5 for quality and 4.89/5 for usefulness/relevance. Following improved accessibility and engagement, attendance increased from 2–3 people to an average 12.6 people.The education team grew, sharing workload and encouraging new ideas. Trainees enthusiastically shared educational updates in the Whatsapp group and asked for teaching opportunities.Communication meetings gave a voice to all trainees, aiding inclusivity. They celebrated positive things and productively discussed challenges. 90% of trainees found teaching helpful and the majority had met most educational goals. Additional support was signposted and changes made, including a new postnatal tips handbook and training.ConclusionA variety of strategies greatly improved local education engagement, and satisfaction. Hybrid teaching delivery maximised attendance and accessibility. Future plans include simulation training, radiology meetings and recorded teaching.ReferencesGMC NTS interactive reports https://www.gmc-uk.org/about/what-we-do-and-why/data-and-research/national-training-surveys-reports